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PLL #2- The Hip:Anatomy, Disease, Injury, and Repair
By: Phil Kemp, Andrew Thistle, Tim
Hersey, Brian Wilson, John BocchinoBNG 345
Professor Currey
To be able to label the parts associated with the hip joint on both the femoral and pelvic sides
To be able to explain how the muscles and ligaments in the hip allow for movement
To deduce and identify common diseases and injuries of the hip
To compare the methods of repairing common hip diseases and injuries, both biologically and surgically
Learning Objectives
Anatomy of the Hip
Ball and Socket joint composed of:
Ilium Ishcium Pubis Femur
Bones That Make up the Hip
Formed by the Ilium, ischium, and pubis.
Deep Socket on the outer edge of the pelvis
The depth of the acetabulum is further increased by a fibrocartilagenous labrum attached to the acetabulum.
Acetabulum
The large round head of the femur rotates and glides within the acetabulum.
The neck of the femur connects the femoral head with the shaft of the femur.
The neck ends at the greater and lesser trochanter prominences.
Femur
Greater Trochanter Bump on the femur and
easy to feel on outside of your thigh
Site for tendons of several muscles to attach.
The lesser trochanter is also a the site for tendon attachment.
Trochanters
As the joint bears more weight, the contact of the surface areas increases as does joint stability.
When standing, the body’s center of gravity passes through the center of the acetabulum.
Biomechanics
Quadriceps Hamstrings Gluteal Group Adductor Group Illiopsoas Group Lateral Rotator Group
Muscles of the Hip
The quads make up about 70% of the thigh’s muscle mass. The purpose of the quads is flexion (bending) of the hip and extension (straightening) of the knee.
Quadriceps
Has a large moment aiding in hip extension.
Hamstrings
Gluteus maximus – main hip extensor and keeps the head of the femur from sliding forward in the hip socket
Gluteus medius – helps keep the pelvis level when walking and helps to abduct the thigh
Gluteus minimus – Works with medius to help abduct the thigh
Gluteal Group
Made up of: adductor brevis, adductor longus, adductor magnus, pectineus, and the gracilis muscles.
Originate on the pubis and insert on the medial, posterior surface of the femur.
Muscles aid in adduction, hence “adductor group.”
Adductor Group
Comprised of the iliacus and psoas major.
The strongest of the hip flexors. Important in standing, walking,
and running.
Iliopsoas Group
Made up of the externus and internus obturators, the piriformis, the superior and inferior gemelli, and the quadratus femoris.
Originate at or below the acetabulum of the ilium and insert on or near the greater trochantor.
Aid lateral rotation of the hip.
Lateral Rotator Group
Hip Tendons and Ligaments
IT Band (Tendon)
IT Band (Iliotibial Band) Runs along femur
from hip to knee
Ligaments
Connect bones to bones
Joint Capsule Pubo-femoral Iliofemoral Ischiofemoral
Provides Stability ligamentum teres-
connects femoral head to acetabulum & supplies femoral head with blood
Ligaments 2
Labrum Facilitate keeping femoral
head in the acetabulum
Nerves
Sciatic nerve large, travels under the gluteus maximus down the
back of the leg and further onto the foot.
Bursae
Sacs of liquid that allow for lubrication between bones, muscles and tendons
http://www.superteachertools.com/jeopardy/usergames/Feb201306/game1360011345.php
Jeopardy
Common Hip Injuries
Common Hip Injuries
Hip Dislocation Hip Fracture Athletic Hip Injuries
Trochanteric Bursitis Hip Pointer Labral Tear Stress Fracture Muscle/Ligament Strain
Hip Dislocation
Difficult to do Ball and Socket joint
very stable Can be acquired or
congenital (hip dysplasia)
Easy to diagnose
Famous example of hip dislocation…
Bo Jackson
http://www.ddotomen.com/2012/12/10/30-for-30-you-dont-know-bo-full-episode/
Hip Fracture
Serious problem in elderly population
Requires surgical repair or replacement
Can lead to further complications
Fracture-Surgical Methods of Repair
Method of Repair depends on: Placement of fracture Surgeons Discretion
http://orthoinfo.aaos.org/topic.cfm?topic=A00392
Athletic Injuries
Trochanteric Bursitis Hip Pointer Labral Tear Stress Fracture Muscle/Ligament Strain
Trochanteric Bursitis
Hip Pointer
Labral Tear
Stress Fracture
Hip Strain/Sprain
Common Hip Diseases
Osteoarthritis (OA)
Most common form of hip arthritis
Chronic condition characterized by the breakdown of cartilage that cushions the ends of the bones where they meet to form joints
“Wear and Tear” Arthritis Results in pain, stiffness,
loss of movement, and potential formation of bone spurs
http://www.joint-pain-expert.net/images/hip-osteoarthritis.JPG
Chronic Inflammatory Disease affecting 1.3 million Americans
Causes: Unknown, but genetics, environmental factors, and hormones have been speculated as potential causes
Results in pain, redness, inflammation, and potentially loss of function and disability
Rheumatoid Arthritis
X-Ray: RA
Arthritis-Methods of Repair
Basic Treatments
Rest Exercise Cane/walker Anti-inflammatory Drugs Cortisone shots Rest and exercise?
Surgical Treatments
Joint Resurfacing Joint replacement
AKA Developmental Dysplasia of the Hip (DDH)
Lifelong condition 1:1000 people Ranges from barely detectable to severely
malformed or dislocated
Hip Dysplasia
Hip Dysplasia X-Ray
Hip Dysplasia-Methods of Repair
Treatment depends on age of diagnosis Infants: brace 6 months to 10 years:
full body brace Older children &
adults: Surgical bone remodeling and/or total joint replacement
Proposed causes: chemotherapy, alcoholism, excessive steroid use, and many others
Most commonly affects the ends of long bones, thus the hip joint is commonly affected by AN
Usually affects people between 30 and 50; about 10-20 thousand people develop AN at the head of the femur each year
Avascular Necrosis
Avascular Necrosis
Avascular Necrosis-Methods of Repair
Most cases eventually require surgery Bone grafts Osteotomy Total Joint
replacement Core Decompression Vascularized bone
graft
Total Hip Replacement
Components:
http://www.exac.com/patients-caregivers/images/img_patients_hip_components.jpg/image_product
Variation in Femoral Stem
Procedure-Pre Operative planning
2D images and stencils are used to determine stem size and neck length
Can this method be improved?
Procedure-Femoral Neck Recision
A 6-8 inch incision is made anteriorly or posteriorly
Hip is dislocated Femoral head and
neck are removed using a bone saw
Procedure-Broaching of Femoral Cavity
Procedure-Implant Placement
Implant is hammered into place
Proper neck and head components are placed on femoral stem
Procedure: Acetabular cup
Acetabular cup region is reamed out of pelvis
Using bone screws, the metal cup is secured in place
Polyethylene cup is compacted into metal cup.
http://www.youtube.com/watch?v=YrSmlwNWAmQ
THR Animation
Result:
Revisionary Surgery Hip replacements
loosen after 10-20 years Aseptic loosening Mechanical loading Stress Shielding
Revisionary implants: longer, wider, more invasive stems
Hip Resurfacing Used on younger
patients in order to preserve bone
http://www.edheads.org/activities/hip/index.shtml
Who Wants to try it!